Operate, actions
Actions
Downstream actions derived from the resolved identities. Proposed actions wait for an operator; suppressed actions wait for a steward decision.
Eligibility engine
1,339
Eligibility conflict resolved
1,339 proposed
Claims processor
9,112
Orphan claim re-pointed
9,112 executed
Outreach
7,319
Outreach address corrected, Outreach suppressed pending steward
2,993 proposed4,326 held
Next-best-action
3,896
Care coordination outreach, New member onboarding
3,896 proposed
Member services
4,974
Duplicate member record retired
4,974 executed
Actions
26,640 derived from the last resolution run
Outreach suppressed pending steward, Outreach, 0 proposed
| Action | Type | Title | Detail | Linked to | Status | Executed | |
|---|---|---|---|---|---|---|---|
| ACT-014295 | Outreach suppressed pending steward Outreach | TPA-58529 (Billy Hayes) held until CASE-000851 is decided |
| Held | — | ||
| ACT-014296 | Outreach suppressed pending steward Outreach | ENR-125445 (Billy Hayes) held until CASE-000852 is decided |
| Held | — | ||
| ACT-014297 | Outreach suppressed pending steward Outreach | ENR-110294 (John Schmidt) held until CASE-000853 is decided |
| Held | — | ||
| ACT-014298 | Outreach suppressed pending steward Outreach | CLM-407824 (John Schmidt) held until CASE-000854 is decided |
| Held | — | ||
| ACT-014299 | Outreach suppressed pending steward Outreach | ENR-115860 (Nathan Black) held until CASE-000855 is decided |
| Held | — | ||
| ACT-014300 | Outreach suppressed pending steward Outreach | TPA-55311 (Nathan Black) held until CASE-000856 is decided |
| Held | — | ||
| ACT-014301 | Outreach suppressed pending steward Outreach | ENR-111009 (Stephen Reyes) held until CASE-000857 is decided |
| Held | — | ||
| ACT-014302 | Outreach suppressed pending steward Outreach | ENR-103263 (Isabella Rice) held until CASE-000858 is decided |
| Held | — | ||
| ACT-014303 | Outreach suppressed pending steward Outreach | CLM-412426 (Brian Brooks) held until CASE-000859 is decided |
| Held | — | ||
| ACT-014304 | Outreach suppressed pending steward Outreach | ENR-123609 (Sophia Robertson) held until CASE-000860 is decided |
| Held | — | ||
| ACT-014305 | Outreach suppressed pending steward Outreach | TPA-57920 (Sophia Robertson) held until CASE-000861 is decided |
| Held | — | ||
| ACT-014306 | Outreach suppressed pending steward Outreach | TPA-60663 (Alexys Washington) held until CASE-000862 is decided |
| Held | — | ||
| ACT-014307 | Outreach suppressed pending steward Outreach | TPA-60662 (Alexys Washington) held until CASE-000863 is decided |
| Held | — | ||
| ACT-014308 | Outreach suppressed pending steward Outreach | TPA-50722 (Martha Harrison) held until CASE-000864 is decided |
| Held | — | ||
| ACT-014309 | Outreach suppressed pending steward Outreach | CLM-429174 (Kayla Harrison) held until CASE-000865 is decided |
| Held | — | ||
| ACT-014310 | Outreach suppressed pending steward Outreach | ENR-138259 (Kalya Harrison) held until CASE-000866 is decided |
| Held | — | ||
| ACT-014311 | Outreach suppressed pending steward Outreach | CLM-410860 (Susan Burke) held until CASE-000867 is decided |
| Held | — | ||
| ACT-014312 | Outreach suppressed pending steward Outreach | CLM-421920 (Kevin Burke) held until CASE-000868 is decided |
| Held | — | ||
| ACT-014313 | Outreach suppressed pending steward Outreach | CLM-406355 (Alexis Robinson) held until CASE-000869 is decided |
| Held | — | ||
| ACT-014314 | Outreach suppressed pending steward Outreach | CLM-406674 (Martha Young) held until CASE-000870 is decided |
| Held | — | ||
| ACT-014315 | Outreach suppressed pending steward Outreach | TPA-58076 (Teresa Yang) held until CASE-000871 is decided |
| Held | — | ||
| ACT-014316 | Outreach suppressed pending steward Outreach | PRV-25428 (Teressa Yang) held until CASE-000872 is decided |
| Held | — | ||
| ACT-014317 | Outreach suppressed pending steward Outreach | PRV-21726 (Noah Pena) held until CASE-000873 is decided |
| Held | — | ||
| ACT-014318 | Outreach suppressed pending steward Outreach | CLM-410842 (Ann Rios) held until CASE-000874 is decided |
| Held | — | ||
| ACT-014319 | Outreach suppressed pending steward Outreach | PRV-23135 (Ann Ryos) held until CASE-000875 is decided |
| Held | — | ||
| ACT-014320 | Outreach suppressed pending steward Outreach | PRV-23136 (Ann Rios) held until CASE-000876 is decided |
| Held | — | ||
| ACT-014321 | Outreach suppressed pending steward Outreach | CLM-419445 (Patricia Flores) held until CASE-000877 is decided |
| Held | — | ||
| ACT-014322 | Outreach suppressed pending steward Outreach | CLM-407173 (Christina Garza) held until CASE-000878 is decided |
| Held | — | ||
| ACT-014323 | Outreach suppressed pending steward Outreach | CLM-405047 (Paul Garza) held until CASE-000879 is decided |
| Held | — | ||
| ACT-014324 | Outreach suppressed pending steward Outreach | CLM-430760 (Paul Aguilar) held until CASE-000880 is decided |
| Held | — | ||
| ACT-014325 | Outreach suppressed pending steward Outreach | CLM-415339 (Margaret Foster) held until CASE-000881 is decided |
| Held | — | ||
| ACT-014326 | Outreach suppressed pending steward Outreach | CLM-405651 (Maria Griffin) held until CASE-000882 is decided |
| Held | — | ||
| ACT-014327 | Outreach suppressed pending steward Outreach | ENR-107428 (Maria Griffin) held until CASE-000883 is decided |
| Held | — | ||
| ACT-014328 | Outreach suppressed pending steward Outreach | TPA-54344 (Stephen Harrison) held until CASE-000884 is decided |
| Held | — | ||
| ACT-014329 | Outreach suppressed pending steward Outreach | TPA-52785 (Janice Ellis) held until CASE-000885 is decided |
| Held | — | ||
| ACT-014330 | Outreach suppressed pending steward Outreach | ENR-135187 (Janice Ellis) held until CASE-000886 is decided |
| Held | — | ||
| ACT-014331 | Outreach suppressed pending steward Outreach | CLM-417418 (Sean Carpenter) held until CASE-000887 is decided |
| Held | — | ||
| ACT-014332 | Outreach suppressed pending steward Outreach | PRV-25167 (Seen Carpenter) held until CASE-000888 is decided |
| Held | — | ||
| ACT-014333 | Outreach suppressed pending steward Outreach | CLM-417417 (Sean Carpenter) held until CASE-000889 is decided |
| Held | — | ||
| ACT-014334 | Outreach suppressed pending steward Outreach | PRV-26257 (Nathan Carpenter) held until CASE-000890 is decided |
| Held | — | ||
| ACT-014335 | Outreach suppressed pending steward Outreach | TPA-62858 (Benjamin Thompson) held until CASE-000891 is decided |
| Held | — | ||
| ACT-014336 | Outreach suppressed pending steward Outreach | ENR-137391 (Heather Evans) held until CASE-000892 is decided |
| Held | — | ||
| ACT-014337 | Outreach suppressed pending steward Outreach | CLM-423870 (Mariana Peterson) held until CASE-000893 is decided |
| Held | — | ||
| ACT-014338 | Outreach suppressed pending steward Outreach | ENR-120948 (Brenda Nichols) held until CASE-000894 is decided |
| Held | — | ||
| ACT-014339 | Outreach suppressed pending steward Outreach | TPA-56972 (Brenda Nichols) held until CASE-000895 is decided |
| Held | — | ||
| ACT-014340 | Outreach suppressed pending steward Outreach | CLM-406286 (Janice Ellis) held until CASE-000896 is decided |
| Held | — | ||
| ACT-014341 | Outreach suppressed pending steward Outreach | TPA-61124 (Martha Hernandez) held until CASE-000897 is decided |
| Held | — | ||
| ACT-014342 | Outreach suppressed pending steward Outreach | CLM-409888 (Peter Vazquez) held until CASE-000898 is decided |
| Held | — | ||
| ACT-014343 | Outreach suppressed pending steward Outreach | ENR-113033 (Peter Vazquez) held until CASE-000899 is decided |
| Held | — | ||
| ACT-014344 | Outreach suppressed pending steward Outreach | CLM-413588 (Melissa White) held until CASE-000900 is decided |
| Held | — |
Derivation rules
Evaluated after every gold rebuild
- 1Eligibility conflict resolvedThe records behind one identity disagree on plan code. Survivorship picks the enrollment plan; the eligibility engine is told which one is canonical.
- 2Orphan claim re-pointedA claim arrived without a member ID. Resolution attached it to an identity that has one, so the claims processor can now pay it against the right member.
- 3Outreach address correctedThe most recent address on the golden record differs from what enrollment holds. Outreach gets the current address before the next mailing.
- 4Outreach suppressed pending stewardThe record is sitting in an open steward case. Nothing sensitive is sent until a person decides, so we never message the wrong member.
- 5Care coordination outreachThree or more claims and no provider record. Next-best-action proposes assigning a PCP and scheduling a care-coordination call.
- 6New member onboardingA single, fresh enrollment with no other activity yet. Next-best-action proposes the welcome kit and a digital ID card.
- 7Duplicate member record retiredTwo or more enrollment records collapsed into one identity. Member services retires the extra cards against the surviving member ID.